Burn Complications Flashcards
A client has circumferential burns. What does this mean?
Burn around like a circle; check circulation!
What is a circulatory check?
Pulse
Cap refill
Skin temp
Skin color
What is turgor?
Hydration check
What check is sensation?
Neurovascular
What if the vascular check in the arm is bad, how do you relieve pressure?
Escharotomy
Fasciotomy
What pressure relief?
Relieves the pressure and restores the circulation, cuts through eschar
Escharotomy
What pressure relief?
Relieves the pressure and restores circulation but cut is much deeper into tissue; cuts through fascia of muscle
Fasciotomy
Renal system
An indwelling catheter is inserted to measure UO. How often?
Hourly
Renal system
T/F: May put in catheter and no UO
T
Kidneys may be trying to hold with little fluid is there or they aren’t being perfused adequately
Renal system
What do you do if UO is brown or red?
Call doc
Renal system
What drug may be given to flush out kidneys?
Mannitol
Renal system
T/F: No diuretics given to burn patients
T and F; may give mannitol only to flush out kidneys
Renal system
What about Mannitol to know
It crystalizes
Do not refridgerate; don’t give if it has crystals
Renal system
If there is no UO or if it is less than 30mL/hr, what to worry about
Kidney failure
Renal system
After 48 hours, what does client begin to do?
Diurese because fluid is going back to vascular space and now we worry about fluid volume excess
Electrolyte imbalance
What happens here?
Burns cause cells to break. Cells have K. If cells break, K leaks and that causes HYPERkalemia
Electrolyte imbalance
S/s of hyperkalemia?
Muscle twitching
Muscle weakness
Flaccid paralysis
Cardiac dysrhythmias
GI system
What may be ordered to prevent stress ulcer?
Magnesium carbonate
Pantoprazole
Famotidine
GI system
What ulcer is common with burns?
Stress ulcer (Curlings)
GI system
Why would doc want client to be NPO and have NG hooked to suction?
Could develop paralytic ileum because decrease vas. volume, decreased GI motility, and HYPERkalemia
GI system
How to help with GI motility to prevent paralytic ileum?
Rocking chair
GI system
What happens if client doesnt have bowel sounds
Abdominal girth increases
GI system
Burns patients need more what?
Calories
Vit C
Protein
GI system
When is NG tube removed?
When you hear bowel sounds
GI system
When you start GI feedings, what should be measured?
Residuals
GI system
When to hold next feed?
If residual is more than 50 mL
*still give back the residual so you don’t cause any imbalances, just don’t give next feed
GI system
How to check proper nutrition and positive nitrogen balance?
Pre-albumin levels
Integumentary-Contractures
Damage only to epidermis
Superficial thickness
Integumentary-Contractures
Damage to entier epidermis and varying depth of dermis
Partial thickness
Integumentary-Contractures
Damage to entire dermis and sometimes fat
Full-thickness
Integumentary-Contractures
If they have burns on hands, what are good ways to prevent contractors?
Wrap each finger separately
Use splints
Integumentary-Contractures
What if neck burns?
Hyperextend neck
No pillows–to promote chin-to-chest contracture
Integumentary-Infections
What is #1 complication with perineal burn?
Infection
Integumentary-Infections
What is eschar?
Dead tissue
*if not removed, new tissue doesnt regenerate
Integumentary-Infections
What likes to grow in eschar?
Bacteria
Integumentary-Tretament
What type of isolation?
Protective
Integumentary-Tretament
What agents to remove necrotic, dead tissue?
Sutilains or collagenase
*both enzymatic drugs
Integumentary-Tretament
Rules for the enzymatic drugs?
Don’t use on face
Don’t use if pregnant
Don’t use over large nerves
Don’t use if area is opened to body cavity
Integumentary-Tretament
What is also used to debrid?
Hydrotherapy
- give pain med before
- worry about cross contamination with immersion hydrotherapy
Integumentary-Tretament
Mafenide acetate
Can cause acid base problems
Stings
If rubs off, apply more
Integumentary-Tretament
Silver nitrate
Keep dressing wet
Can cause electrolyte problems
Integumentary-Tretament
Providone-iodine
Stings and stains
Can cause allergies
Can cause acid-base problems
Integumentary-Tretament
Why to alternate antibiotic drugs?
Bacteria can build resistance or tolerance
Integumentary-Tretament
Broad spectrum antibiotics are avoided why?
To prevent superinfection or secondary infections
*broad spectrum antibiotics may be used until wound cultures have returned–always get culture before starting antibiotic
Integumentary-Tretament
Mycin drugs
Worry about BUN or Cr increasing (neprotoxicity)
Worry about hearing (ototoxicity)
Integumentary-Grafting
How much to remove of burn tissue?
Till you see healthy tissue
Integumentary-Grafting
What is an autograft?
Autograft uses own skin
Good skin taken from healthy donor site and placed over burned area –donor site= open wound and dressing applied till bleeding stops –then donor site is left open to air
Integumentary-Grafting
If client is well nourished, how often can the surgeon reharvest from same donor site?
Every 12-14 days
Integumentary-Grafting
If skin graft becomes blue or cool, what does this mean?
Poor circulation
Integumentary-Grafting
Why would doc want you to roll sterile Q-tips over graft with steady gentle pressure from center of graft out to edges?
To get fluid out between graft and tissue to keep graft site intact (aka keep graft to adhere)
